Ruminations by a non-academic general surgeon from the heart of the rust belt.

Monday, March 23, 2009

Waiting Room

Recently, I had to operate on a frail, elderly male on a Sunday morning for an incarcerated inguinal hernia. He had a bazillion medical problems, including stage IV lung cancer, and he had been deteriorating health-wise for the past several months. He'd lost weight, didn't go out much, couldn't golf anymore, but he seemed happy enough, accompanied by his wife at 4am in the ER. He really did. You can tell those kinds of things about people without asking. An incarcerated inguinal hernia, however, is a mechanical problem and there isn't much to offer someone suffering from the pain of one other than an operation. We went through the risks. He'd had a heart attack just two months ago. His lung cancer compromised his ability to tolerate general anesthesia and obviously increased his risks of post-op pulmonary morbidity. He was bad protoplasm, as we say.

The operation went fairly well. It was a recurrent hernia, had been fixed in the 1970's via one of the old "tissue repair" techniques (i.e Bassini, McVay, etc), so there was distorted anatomy, obscured landmarks, and a generalized snarled tangle of scar tissue. A knuckle of purplish bowel was trapped in the defect and I had to do a limited resection. It came together nice though. He did well. He went to the ICU extubated, stable, you couldn't ask for more.

After surgeries, I write orders, I dictate, and then I go talk to the family. I try to do it the same way every time so I don't forget anything. After the paper work, I found myself mindlessly ambling down a long, hushed hallway like an automaton, formulating in my mind things yet to be done, a consult to see, stuff to do around the house when I got home. The waiting area is off to the right at the end of this hall through a wide archway. Just before my physical body loomed in the middle of said archway, I stopped suddenly, catching something undefined in my peripheral vision. I stopped just short of the archway, but close enough so that I could still scan the waiting room. In a chair by the window was the little old wife, sitting quiet and motionless in the sunlight. She was waiting. There was no one else in the expansive room and it was quiet. The TV was off. She didn't move she seemed swallowed up almost in one of those cushiony, ridiculously large waiting room chairs, shoulders slumped, not moving, staring off through the window without giving the impression she was looking at anything in particular. She was a small woman, compact and contained. She wasn't frail. She was just small. She wore oversized glasses and her head barely cleared the back of the chair. Her shoulders sloped like a gentle backyard declivity. The light of the room made shadows pool in the crannies of her clavicles. She looked engulfed by the chair. Her hands were folded together in front of her like she was making a little cabin or a teepee, her fingers bent and crooked like weather-warped lumber. She didn't move. She wasn't talking on the cell phone or reading the paper or checking her watch or watching television or chewing on a pencil while trying to figure some crossword puzzle or the Jumble. Who knows what she thought about. She just kept looking out the window, without moving, with this almost beatific smile, one of those slight, subtle smiles that you don't really notice unless you stare at someone for a time. It was that time of the year when winter was starting to break and it was warmer out and the sun was starting to acquire a real presence, shedding that meek, gauzy glow of winter and the sun was out in force that Sunday morning and the rays beamed in through the windows with a golden linearity and caught the silvery strands of her hair and the creased wrinkles of her exhausted-looking, wan face and I simply couldn't move for a minute or so, staring unseen from my voyeuristic perch, watching this silent old woman abiding in patient repose. Patiently waiting for word of her husband.

I finally went in and sat down beside her. I told her everything was fine. She smiled at me and said, I'm so happy. Her hands were still folded. Her eyebrows arched and she said it again, I'm so happy, and nodded her head, the first movement I'd seen her make since I'd decided to gawk at her. I sat there for a while longer than I usually do. I asked her things about their life together, where they'd been, what they did for work, their children and grandchildren, etc., and she told me things about herself that I didn't know and would probably soon forget. But it was nice.

I know, I know, it sounds hokey as all hell. I can anticipate the sniggers and arch-ironic dismissal of yet another corny "doctor as healer" story. I get that. And it's fine. I usually get annoyed with that kind of a schmaltz-fest. But this was real. It was one random Sunday morning in the nascent Ohio spring. The old couple eventually left the hospital together. I may see them again at the two week follow up appointment, but I rather hope they skip it, off doing something unstructured and fun, something that doesn't require any more patience....

8 comments:

Bla Bla Bla... the Happy Hospitalist would have told us how to Code it for the maximum reimbursement value... I hope you ran it by the Hospital's Medical Ethics Weenies...Hopefully he won't have one of those Post Operative PEs that aren't supposed to happen anymore...

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